Medicare plan choices can be very confusing, and I encourage my clients to learn as much as possible about all options, before making a decision. After hearing about some very bad experiences with Medicare Advantage plans (which are the least expensive option because they are structured like HMOs) I am advising all of my clients to avoid Medicare Advantage Plans, even though those plans are less costly in the short-run. The main problem with Medicare Advantage plans is that coverage for rehab and skilled care can be cut short by a determination of “lack of medical necessity” — with little basis by the medical professional or the nursing facility, and little recourse for the patient. Recently, I learned of two stroke victims who were shipped back home, barely being able to walk or feed themselves, because of supposed “lack of medical necessity.” This is a financial disaster for families, because the cost of private pay in a rehab facility can cost $7,500 and up per month. With traditional Medicare and a supplemental (or Medigap) policy, patients are entitled to up to 100 days of rehab. Here is a link to a very good article on the “Pitfalls of Medicare Advantage Plans” from Investopedia: Medicare Advantage Pitfalls
The Nightmare of Medicare Advantage Plans
